Background. The suicide rate in cancer patients is twice the rate in the general population. Cancer patients are also at greater risk for suicidal ideation than the general population. Negative religious coping (NRC) or spiritual struggle has been associated with negative states in cancer patients including worse quality of life, greater distress, higher levels of depression, and lower life satisfaction. Further, NRC has been associated with an increased risk for suicidal ideation in psychiatric patients with psychosis and individuals experiencing a natural disaster. However, the relationship between NRC and suicidal ideation in patients with advanced cancer is not known.

Objective. This study examines the relationship between NRC and suicidal ideation in patients with advanced cancer, controlling for significant demographic and disease characteristics and risk and protective factors for suicidal ideation. This study also examines the moderating effects of gender, race, age, and income on the relationship between NRC and suicidal ideation.

Methods. Adult patients with advanced cancer (life expectancy ≤6 months) were recruited from seven sites across the United States (n=603). Trained raters verbally administered the examined measures to patients upon study entry. Validated scales were used to assess suicidal ideation (Yale Evaluation of Suicidality), positive and negative religious coping (Brief RCOPE), and risk (physical symptoms, performance status, psychiatric disorders) and protective factors (quality of life, self-efficacy, secular coping, social support, global religiousness/spirituality, spiritual care received) for suicidal ideation. Due to a positive skew in NRC, the sample was dichotomized into participants who endorsed any level of NRC (n=223) and those who did not endorse NRC (n=380). Multivariable logistic regression analyses regressed suicidal ideation on NRC controlling for significant demographic, disease, risk and protective factors.

Results. NRC was associated with an increased risk for suicidal ideation (OR, 2.65 [95% CI, 1.22, 5.74], p=.01) after controlling for demographic and disease characteristics, mental and physical health, self-efficacy, secular coping, social support, spiritual care received, global religiousness and spirituality, and positive religious coping. Gender, age, and income moderated the relationship between NRC and suicidal ideation. Women, patients younger than 65 years old, and patients with an annual income of $50,999 or less who endorsed NRC were at increased risk for suicidal ideation. The relationship between NRC and suicidal ideation was not significant for men, patients older than 65 years, and patients with an annual income of $51,000 or greater.

Conclusions. NRC is a robust correlate of suicidal ideation. Endorsement of any NRC was associated with over two times the odds of suicidal ideation after controlling for disease and demographic characteristics, risk and protective factors for suicidal ideation, and positive religious coping. Even at low levels, NRC may be an important risk factor for psychiatric distress in advanced cancer patients. NRC may be a particularly important predictor of suicidal ideation in women, younger patients, and patients with fewer financial resources. Assessment of NRC in patients with advanced cancer may identify patients experiencing spiritual distress and those at risk for suicidal ideation; interventions targeting NRC might reduce suicidal ideation in this population.

Spiritual and Religious Dimensions of Coping among Low-Income Depressed Mothers: A Qualitative Analysis

It is well established that low-income mothers suffer disproportionately from untreated depression and exposure to violent trauma, which has a negative impact on both maternal and child well-being. Research has shown that many of these women make use of spiritual and/or religious resources as they work to understand and cope with their adverse circumstances. However, most of the research in this area has been quantitative in nature, with a goal of determining whether spiritual and/or religious coping is associated with fewer depression symptoms rather than of describing the nature of this coping and its relationship to mothers’ views about their symptoms (see for example Levy & O’Hara 2010; Jesse et al 2005). As a result, little is known about how spiritual and religious coping actually functions in mothers’ lives, much less how their perspectives might affect recommendations for clinical care.

Responding to this gap, this presentation will discuss results and initial analysis from a qualitative study on spiritual and religious coping practices among low-income urban mothers who have a history of depression. Our semi-structured interview method seeks out participants’ explanatory models for depressive symptoms, asks mothers to describe and reflect on their spiritual and religious coping practices, and guides participants through a discussion of mental health attitudes and behaviors on their own terms. We further ask the women to share how the experience of being a mother in particular has shaped their spiritual practices, and we administer a quantitative survey to screen for past traumatic events. Bringing together the insights from these investigative threads, our paper will present a work-in-progress synthesis of our findings to date in order to begin a conversation about both form and content in maternal mental health research. Our content will provide one example of bridging the gap between provider, researcher, and patient understandings of mental illness. Specifically, we will discuss case studies from our research that address how women in our particular urban community view the complex relationship between their spirituality and their mental health. Our discussion of form will illustrate the complex significance of qualitative and interpretive methods within the array of approaches to mental health research, especially when investigating the connection to specific individuals’ religion and spirituality.

There is great need for creative solutions to better connect low income mothers with mental health treatment that is fully acceptable to them. Without a nuanced understanding of the ways that mothers experience and cope with their depression, including a robust exploration of spiritual themes, it will be difficult for us to chart a path to this goal. Our presentation will offer one example of a strategy to move us closer.

Healing the Healers: Burnout, Spirituality, and Coping Among Physicians and Clergy

Benjamin Doolittle, MD, MDiv, Yale School of Medicine

Burnout is a heterogeneous syndrome characterized by emotional exhaustion, detachment, and lack of accomplishment. Among physicians and clergy, the prevalence of burnout is between 30-78%. Physicians and clergy share many similar stressors: long hours, complicated work-life balance, and multiple job demands. Yet, physicians and clergy often have dramatically different pay scales and job expectations.

This presentation discusses the latest empirical research among the two groups and contrasts their different burnout prevalence, coping strategies, and spiritual outlook using data from the Yale Burnout Project.* Using validated instruments emotional exhaustion was higher among the resident physician cohort (86%) than clergy (19%). In contrast, personal accomplishment – a key component of the burnout syndrome – was also high in both groups (physicans 87%, clergy 46%), suggesting that both physicians and clergy experience job satisfaction despite their emotional stress and detachment. In both groups, spirituality correlated positively with personal accomplishment: physicians (rho= +0.28, p<.003), clergy (rho=+0.50, p<.0001)

The implications of these findings suggest that there may be a “burnout personality” – a constellation of coping strategies and spiritual attitudes which may place a person at risk for burnout. Because burnout is a complex syndrome of emotional coping, successful mitigation requires a multi-factorial approach, including individual commitment to self-care as well as an institutional commitment to wellness.